A20-year-oldhealthywomandevelopedsuddenonset,fluctuatinggaitunsteadiness.Shebecameprogressivelyconfusedovera2-weektimeperiodandwassenthomeaftershewasfoundwanderingthehallsofhercollegedormitory.Herparentsnotedpersonalitychangesandslowedthinking.Severaldayslatershedevelopedaleftfacialdroopandleft-sidedarmandlegweakness,promptingevaluationatherlocalemergencydepartment.
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Vitalsignswerewithinnormallimits.Neurologicexaminationwasnotableformarkedabuliaandinattentiveness,rightlateralend-gazenystagmus,lefthemiparesis,andleft-sideddysmetria.Sherequired2-personassistforambulation.
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Questionsforconsideration:
1.Whatlevelorlevelsofthenervoussystemareinvolved?
2.Whatisthemostappropriatenextdiagnostictest?
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SECTION2µÚ¶þ²¿·ÖThispatient¡¯sconstellationofsymptomssuggestsasubacuteprogressiveprocesswithbihemispheric,brainstem,andcerebellarinvolvement.Giventhefocalfindingsonherexamination,brainMRIwithoutandwithcontrastwasobtainedasthefirstdiagnosticstep(figure1).
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Questionforconsideration:
1.Basedontheimagingfindings,whatisyourdifferentialdiagnosis?
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SECTION3µÚÈý²¿·ÖTheMRIshowedmultifocalabnormalitiesofbothwhiteanddeepgraymatterstructures.Themoststrikingfeaturewasthemultiplecorpuscallosumlesions.Whilenotpathognomonicforaspecificetiology,prominentcorpuscallosalinvolvementnarrowsthedifferentialdiagnosis(table).
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Infarctionisolatedtothecorpuscallosumisrelativelyraregivenitsrobustcollateralbloodsupply.Wheninfarctionsoccur,thespleniumismostoftenaffected,followedbythebodyandgenu.1Ischemiclesionsaretypicallylateralizedandconfinedtotheanteriororposteriorhalfofthecorpuscallosumgiventhedualcontributionsfromtheanteriorandposteriorcirculations,respectively.Arteriopathieswouldbetheexceptiontothispattern,suchascerebralautosomaldominantarteriopathywithsubcorticalinfarctsandleukoencephalopathyandSusacsyndrome(SS),bothofwhichcandiffuselyinvolvewhitematterstructures.2
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Withitspredominanceofmyelinatedfibers,thecorpuscallosumisalsoaffectedbydemyelinatingdisease,includingmultiplesclerosis(MS)andacutedisseminatedencephalomyelitis(ADEM).1CallosallesionsinMStendtobesmallandinvolvetheinferioraspect.ADEMcauseslargerlesionsthatoftencrossthemidlineandmayreachtheupperandlowermarginsofthecallosum.Theseareusuallyac白癜风治疗得多少é’?白癜风怎么诊æ–症狀
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